Diabetes mellitus is a disease of the endocrine system associated with pathological changes in the hormonal background and metabolic failures.
To date, the disease is not amenable to eradication (complete elimination). The destructive process in the body can be slowed down by medication and diet therapy, but it is impossible to stop it and start it in the opposite direction.
The types of diabetes mellitus (DM) are defined by the World Health Organization and have no fundamental differences throughout the medical world. Diabetes mellitus of any type is not a contagious disease.
Diabetes mellitus can be of several types, as well as different types. Since the treatment for each species and type is different, it is necessary to know which particular variant of the disease has arisen.
Typing of the pathology
There are several types of the disease, united by one main symptom - an increased concentration of glucose in the blood. The typification of diabetes mellitus is due to the causes of its appearance. Methods of therapy, sex and age of the patient are also applied.
Medically accepted types of diabetes:
- the first type is insulin-dependent (IDDM 1) or juvenile;
- the second is insulin dependent (INZDM 2), or insulin resistant;
- gestational diabetes mellitus (GDM) in the perinatal period in women;
- other specific types of diabetes, including:
- damage to the β cells of the pancreas at the genetic level (varieties of MODY-diabetes);
- pathology of the exocrine function of the pancreas;
- hereditary and acquired pathologies of the glands of external secretion and their functions (endocrinopathy);
- pharmacologically determined diabetes;
- diabetes as a consequence of congenital infections;
- DM associated with genomic pathologies and hereditary defects;
- impaired glycaemia (blood sugar) on an empty stomach and impaired glucose tolerance.
Pre-diabetes is a borderline state of the body, when the blood glucose level changes upwards (glucose tolerance is impaired), however, the blood sugar indicators "fall short" of the generally accepted digital values corresponding to the true diabetes. According to the World Health Organization (WHO 2014), more than 90% of endocrinologist patients suffer from the second type of disease.
According to medical statistics, there is a clear trend of increasing the number of cases worldwide. In the last 20 years, the number of type 2 diabetics has doubled. GDM accounts for around 5% of pregnancies. Specific types of diabetes are extremely rare, accounting for a small percentage of medical statistics.
By gender, NIDDM 2 is more common in premenopausal and menopausal women. This is due to a change in hormonal status and a set of extra pounds. In men, the most common factor in the development of type 2 diabetes is chronic inflammation of the pancreas due to the toxic effects of ethanol.
Insulin-dependent diabetes (type 1)
Type 1 diabetes is characterized by the failure of pancreatic cells. The organ does not fulfill its endocrine (intrasecretory) function of producing insulin, the hormone responsible for supplying glucose to the body. As a consequence of the accumulation of glucose in the blood, the organs do not receive adequate nutrition, including the pancreas itself.
To mimic the natural production of the endocrine hormone, the patient receives lifelong injections of medical insulin with different durations of action (short and long), as well as diet therapy. The classification of type 1 diabetes mellitus is dictated by the various etiologies of the disease. The insulin-dependent type of the disease has two causes: genetic and autoimmune.
genetic cause
The formation of pathology is associated with the biological characteristic of the human body to transmit its characteristic features and pathological abnormalities to subsequent generations. In relation to diabetes, a child inherits a predisposition to the disease from parents or close relatives who have diabetes.
Important! The predisposition is inherited, but not the disease itself. There is no 100% guarantee that a child will develop diabetes.
autoimmune cause
The occurrence of the disease is due to a functional failure of the immune system when, under the influence of negative factors, it actively produces autoimmune antibodies that have a destructive effect on the cells of the body. The triggers (push) to initiate autoimmune processes are:
- unhealthy eating behavior combined with physical inactivity;
- failure of metabolic processes (carbohydrates, lipids and proteins);
- critical deficiency in the body of cholecalciferol and ergocalciferol (vitamins of group D);
- pathology of the pancreas of a chronic nature;
- history of mumps (mumps), measles, herpes Coxsackie virus, Epstein-Barr virus, cytomegalovirus, viral hepatitis A, B, C;
- distress (prolonged permanence in a state of neuropsychological stress);
- chronic alcoholism;
- incorrect treatment with drugs containing hormones.
IDDM is formed in children, adolescents and adults under the age of thirty. The childhood variant of type 1a diabetes development is associated with complicated viral infections. Form 1b occurs in young people and children in the context of autoimmune processes and hereditary predisposition. The disease usually develops rapidly over a few weeks or months.
Insulin resistant diabetes (type 2)
The difference between type 2 and type 1 diabetes is that the pancreas does not stop producing insulin. Glucose is concentrated in the blood and does not reach the cells and tissues of the body due to its lack of sensitivity to insulin: insulin resistance. To a certain extent, the treatment is carried out through hypoglycemic drugs (sugar reducers) and diet therapy.
To compensate for the imbalance in the body, the pancreas activates the production of the hormone. Working in emergency mode, the organ wears out over time and loses its intrasecretory function. Type 2 diabetes becomes insulin dependent. The decrease or loss of cellular susceptibility to the endogenous hormone is mainly associated with obesity, in which the metabolism of fats and carbohydrates is disturbed.
This is especially true of visceral obesity (fat deposition around internal organs). Also, with excess body weight, blood flow is hampered due to numerous cholesterol plaques inside the vessels, which form during hypercholesterolemia, which always accompanies obesity. The cells of the body, therefore, are deficient in nutrition and energy resources. Other factors that influence the development of NIDDM include:
- Alcohol abuse;
- gastronomic addiction to sweet dishes;
- chronic diseases of the pancreas;
- pathology of the heart and vascular system;
- excesses in food in the context of a sedentary lifestyle;
- incorrect hormone therapy;
- complicated pregnancy;
- dysfunctional heredity (diabetes in parents);
- distress.
Most often, the disease develops in women and men of the 40+ age category. At the same time, type 2 diabetes is latent and may not show serious symptoms for several years. Early testing of blood glucose levels can detect prediabetes. With appropriate therapy, the prediabetic state is reversible. If time is lost, it progresses and NIDDM is subsequently diagnosed.
diabetes lada
In medicine there is the term "Diabetes 1. 5", or the name Lada diabetes. This is an autoimmune disorder in the production of hormones and the failure of metabolic processes that occurs in adults (over 25 years of age). The disease combines the first and second types of diabetes. The development mechanism corresponds to IDDM, the latent course and symptom manifestation are similar to NIDDM.
Triggering factors for the development of pathology are autoimmune diseases in the patient's history:
- non-infectious inflammation of the intervertebral joints (ankylosing spondylitis);
- irreversible disease of the central nervous system - multiple sclerosis;
- granulomatous inflammatory pathology of the gastrointestinal tract (Crohn's disease);
- chronic inflammation of the thyroid gland (Hashimoto's thyroiditis);
- juvenile and rheumatoid arthritis;
- discoloration (loss of pigment) of the skin (vitiligo);
- inflammatory pathology of the mucosa of the colon (ulcerative colitis);
- chronic damage to connective tissue and glands of external secretion (Sjogren's syndrome).
In combination with hereditary predisposition, autoimmune disorders lead to the progression of Lada diabetes. To detect the disease, basic diagnostic methods are used, as well as blood microscopy, which determines the concentration of immunoglobulins of the IgG class to antigens - ELISA (enzyme immunoassay). The therapy is carried out through regular injections of insulin and nutritional correction.
Gestational form of the disease.
GDM is a specific type of diabetes that develops in women in the second half of the perinatal period. The disease is most often detected during the second routine examination, when the expectant mother undergoes a comprehensive examination. The main feature of GDM that is similar to type 2 diabetes is insulin resistance. The cells of the body of a pregnant woman lose sensitivity (sensitivity) to insulin due to the correlation of three main reasons:
- hormonal reorganization. During the gestation period, the synthesis of progesterone (a steroid sex hormone) increases, which blocks the production of insulin. In addition, the endocrine hormones of the placenta, which tend to inhibit insulin production, are gaining strength.
- Double burden on the female body. To provide adequate nutrition to the fetus, the body requires an increased amount of glucose. A woman begins to consume more monosaccharides, which causes the pancreas to synthesize more insulin.
- An increase in body weight against the background of a decrease in physical activity. Glucose, abundantly supplied to the body, accumulates in the blood, as cells refuse to take insulin due to obesity and physical inactivity. The expectant mother and fetus in this situation experience nutritional deficiencies and energy starvation.
Unlike type 1 and 2 diabetes, gestational diabetes is a reversible process because insulin molecules and pancreatic functionality are preserved.
Properly selected therapeutic tactics guarantee the elimination of pathology after childbirth in 85% of cases. The main method of treatment of GDM is the diabetic diet "Table No. 9". In difficult cases, injections of medical insulin are used. Hypoglycemic drugs are not used due to their teratogenic effects on the fetus.
Besides
The specific types of diabetes are genetically determined (MODY-diabetes, some types of endocrinopathies) or caused by other chronic pathologies:
- diseases of the pancreas: pancreatitis, hemochromatosis, tumor, cystic fibrosis, mechanical trauma and surgery of the gland;
- functional failure of the anterior pituitary gland (acromegaly);
- increased synthesis of thyroid hormones (thyrotoxicosis);
- hypothalamic-pituitary-adrenal pathology (Itsenko-Cushing syndrome);
- tumors of the adrenal cortex (aldosteroma, pheochromocytoma, etc. ).
A separate diabetic pathology: diabetes insipidus is characterized by a decrease in the production of the hypothalamic hormone vasopressin, which regulates fluid balance in the body.
diagnostic measures
The diagnosis of diabetes mellitus (of any type) is possible only on the basis of the results of laboratory blood microscopy. The diagnosis consists of several consecutive studies:
- General clinical blood test to detect hidden inflammatory processes in the body.
- Blood test (capillary or venous) for glucose content. Produced strictly on an empty stomach.
- GTT (glucose tolerance test). It is carried out to determine the body's ability to absorb glucose. The tolerance test is a double blood sample: fasting and two hours after the "glucose load", which is an aqueous solution of glucose prepared in a proportion of 200 ml of water per 75 g. substances
- HbA1C analysis for the level of glycosylated (glycated) hemoglobin. Based on the results of the study, a retrospective of blood sugar levels over the past three months is evaluated.
- Blood biochemistry. Indicators of liver enzymes aspartate aminotransferase (AST), alanine aminotransferase (ALT), alpha-amylase, alkaline phosphatase (AP), bilirubin (bile pigment), cholesterol levels are evaluated.
- A blood test for the level of antibodies against glutamate decarboxylase (GAD antibodies) determines the type of diabetes mellitus.
Blood Sugar Reference Values and Disease Indicators
| Analysis | for sugar | glucose tolerance test | Glycosylated hemoglobin |
|---|---|---|---|
| rule | 3. 3 - 5. 5 | <7, 8 | ⩽ 6% |
| prediabetes | 5. 6 - 6. 9 | 7. 8 - 11. 0 | from 6 to 6, 4% |
| diabetes | >7. 1 | >11. 1 | More than 6. 5% |
In addition to blood microscopy, a general urinalysis is examined for the presence of glucose in the urine (glycosuria). In healthy people, there is no sugar in the urine (for diabetics, 0. 061 - 0. 083 mmol / l is considered an acceptable norm). A Reberg test is also done to detect the protein albumin and a product of protein metabolism of creatinine in the urine. Also, hardware diagnostics are prescribed, which include an ECG (electrocardiogram) and an ultrasound scan of the abdominal cavity (with kidneys).
Results
Modern medicine classifies diabetes into four main types, depending on the pathogenesis (origin and development) of the disease: insulin dependent (IDDM type 1), non-insulin dependent (NIDDM type 2), gestational (pregnant GDM), specific (DM includes several types diseases caused by genetic defects or chronic pathologies). Gestational diabetes, formed in the perinatal period, is curable. Prediabetes (impaired glucose tolerance) is considered reversible if diagnosed early.